Healthcare Provider Details

I. General information

NPI: 1508935636
Provider Name (Legal Business Name): MICHELE RENICK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25882 ORCHARD LAKE RD STE 105
FARMINGTON HILLS MI
48336-1294
US

IV. Provider business mailing address

2241 HEDGEROW RD UNIT F
COLUMBUS OH
43220-6341
US

V. Phone/Fax

Practice location:
  • Phone: 248-442-6600
  • Fax: 248-564-0946
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30021071
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: